Caring for the Tiniest Hearts

CUIMC/NYP’s Specialized Unit for Newborns with Heart Disease

A healthy newborn’s heart is about the size of a walnut, but these minute hearts can have a multitude of life-threatening abnormalities in the arrangement of the vessels, valves, and chambers. Each year CUIMC surgeons repair congenital heart defects in almost 150 newborns. These patients, who weigh as little as 500 grams (1.1 pounds), benefit from the Columbia surgery team’s expertise in intricate and complex cardiac procedures. With the opening of The Vivian and Seymour Milstein Family Infant Cardiac Unit at NewYork-Presbyterian Morgan Stanley Children’s Hospital, CUIMC has expanded the scope of care it provides.

The state-of-the-art, 17-bed Infant Cardiac Unit is dedicated solely to cardiac care for infants up to three months old. “The new cardiac neonatal intensive care unit (NICU), the first of its kind in the world, allows specialists in neonatal intensive care to work closely with pediatric cardiologists and cardiothoracic surgeons to enhance the outcomes of infants having surgery for complex congenital heart disease,” says Richard Polin, MD, chief of Neonatology.

From the beds to the medical and surgical equipment, everything in the unit is designed for the tiniest newborns. The unit offers specialized modes of hemodynamic support such as ECMO (extracorporeal membrane oxygenation) machine, cardiac assist devices that replace the function of the heart such as the Berlin Heart, and 3-D printing, which enables surgeons to examine precise replicas of each infants’ heart to help plan surgery.

CUIMC surgeons are extraordinarily skilled at repairing a range of complex congenital heart disease (CHD), for instance transposition of the great arteries, hypoplastic left heart syndrome, tetralogy of Fallot, total anomalous pulmonary venous connection, and truncus arteriosus. Many of these conditions are identified prenatally by specialists in CUIMC’s Carmen & John Thain Center for Prenatal Pediatrics (CPP), or at other centers and are then referred to CUMC for care. Lynn Simpson, MD, director of the CPP, says “A third of patients seen in the CPP are diagnosed with fetal heart defects, and I know our patients will appreciate the specialized care their infants will receive in the new cardiac NICU.”

NYP is the largest CHD referral center in the region. In addition to the neonatal cardiac surgeries, the team performs about 600 surgeries every year in older children and in a growing number of adults who have survived to adulthood with CHD because of improvements in care. Emile Bacha, MD is director of congenital and pediatric cardiac surgery at the hospital, and chief of cardiac, thoracic and vascular surgery at CUIMC. “Not only do we have outstanding surgeons who can perform complicated open-heart surgeries on a three-pound baby, but we have a comprehensive multidisciplinary team who are all experts in neonatal care,” he says.

Dr. Ganga Krishnamurthy, medical director of the Infant Cardiac Unit, notes that it’s important to operate on many infants with CHD as soon as possible after birth, despite their low birth weight or early delivery. Waiting has not only been shown to be of no benefit, she says, but can increase babies’ risk of infection as they wait in the ICU—so surgeons prefer to operate when the risk is lowest. As a result, cardiac surgeons are operating on smaller and smaller infants. At CUIMC the smallest patient to undergo cardiac surgery weighed just 500 grams (1.1 pound). “If surgeons are moving in this direction we need to adapt the way we take care of these babies before and after surgery,” says Dr. Krishnamurthy.

Infants with CHD are generally cared for in a general pediatric ICU or a cardiac ICU. Columbia has not only created a separate dedicated unit, but is providing dedicated services, since the expertise needed to care for these babies is uniquely specialized. Every doctor who cares for babies in the new unit is board-certified in both neonatology and in cardiac intensive care. “That differentiation matters and I don’t think that level specialization exists anywhere else,” Dr. Krishnamurthy says.

The infant cardiac unit is already attracting attention. Prestigious hospital cardiac units from across the country, and the world, have asked to tour the facility. “Our main goal is to continue to improve patient outcomes, and we’ll be able to do that with this unit,” says Dr. Bacha. “If someone comes and decides to ‘copy’ it, that’s a good thing.”